Both hyperlipidemia and hypertension are complications of chronic renal failure and hemodialysis frequently persist despite successful renal transplantation; reports of accelerated atherosclerosis in chronic renal failure patients treated with either modality are accumulating. We aim to determine whether an alternate-day corticosteroid regimen reduces the prevalence of these two atherogenic risk factors in comparison with a daily regimen, as suggested by our retrospective studies. We propose to carefully describe plasma lipids and blood pressure in renal transplant candidates and, after transplantation, randomly allocate these patients to either a daily or an alternate-day corticosteroid regimen and repeat studies when maintenance immunosuppression is achieved. To define the specific effect of corticosteroid dose spacing on these risk factors, plasma lipids and blood pressure will be serially studied in a separate group of stable, normotensive, normolipidemic renal transplant recipients currently on alternate-day steroids, after 3 months of a daily regimen and again after reinstitution of alternate-day therapy. Concurrently with the above protocols, detailed studies of lipid and carbohydrate metabolism, and of the activity of the renin-angiotensin system will be carried out in order to elucidate the mechanisms by which corticosteroids might contribute to post-transplant hyperlipidemia and hypertension. These studies will demonstrate the effect of corticosteroid dose scheduling on two important atherogenic risk factors and will elucidate mechanisms underlying their pathogenesis. It may offer a solution to these problems in patients receiving chronic cortocosteroid therapy.